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目的分析2013年5月1日—2015年5月31日期间甘肃省武威市单耐药、多耐药和耐多药肺结核病监测结果,了解武威市耐药肺结核病的流行状况和特点,为今后制定和完善防控措施提供科学依据。方法对痰涂片阳性的肺结核病患者痰液进行培养并鉴定结核分枝杆菌菌种,培养阳性的结核分枝杆菌采用比例法药物敏感试验(DST)判断患者是否耐药,用Spss 13.0软件进行描述性统计学分析。结果 158例肺结核病患者中,41例耐药,总耐药率25.95%;其中RFP耐药率16.46%、INH耐药率18.35%、EMB和Ofx耐药率均为4.43%、Sm耐药率17.09%、Km耐药率3.16%、Am耐药率1.27%、Cm耐药率0.63%;一线抗结核药物总的耐药顺位为INH>Sm>RFP>EMB,二线抗结核药物总的耐药顺位为Ofx>Km>Am>Cm;单耐药率7.59%、多耐药率6.33%、耐多药率12.03%;不同分类肺结核病患者之间发生单耐药(χ~2=1.20)与多耐药(χ~2=1.61)均无明显区别,发生率差异无统计学意义(均P>0.05);不同分类的肺结核病患者之间复治失败患者发生耐多药情况最多,耐多药发生率差异有统计学意义(χ~2=36.62,P<0.05)。结论武威市肺结核病耐多药情况较为严重,应准确利用DST的价值,合理制定化疗方案,落实医务人员面视督导患者服药的策略,控制耐药结核病的发生。
Objective To analyze the surveillance results of single drug-resistant, multi-drug-resistant and multi-drug resistant pulmonary tuberculosis in Wuwei City, Gansu from May 1, 2013 to May 31, 2015. To understand the prevalence and characteristics of drug-resistant pulmonary tuberculosis In the future to develop and improve prevention and control measures to provide a scientific basis. Methods sputum smear-positive patients with tuberculosis were cultured and identified Mycobacterium tuberculosis, culture-positive Mycobacterium tuberculosis using proportion method drug susceptibility test (DST) to determine whether the patient resistant, with Spss 13.0 software Descriptive statistical analysis. Results Among the 158 patients with pulmonary tuberculosis, 41 were drug-resistant with a total drug resistance rate of 25.95%. The RFP resistance rate was 16.46%, the INH drug resistance rate was 18.35%, the EMB and Ofx drug resistance rates were 4.43% 17.09%, Km resistance rate 3.16%, Am resistance rate 1.27%, Cm resistance rate 0.63%; The first-line anti-tuberculosis drug resistance sequence for the total INH> Sm> RFP> EMB, second-line anti-TB drug resistance The order of drug was Ofx> Km> Am> Cm; single drug resistance rate was 7.59%, multi-drug resistance rate was 6.33%, multi-drug resistance rate was 12.03%; single drug resistance was found between different categories of tuberculosis patients ) And multidrug resistance (χ ~ 2 = 1.61), there was no significant difference in the incidence between the two groups (all P> 0.05); patients with different categories of pulmonary tuberculosis failed to return to treatment, The incidence of MDR was statistically significant (χ ~ 2 = 36.62, P <0.05). Conclusions The MDR-TB situation in Wuwei City is more serious. The value of DST should be accurately used, and the chemotherapy regimen should be formulated reasonably to implement the strategy of medical staff to supervise the patient’s medication and to control the occurrence of drug-resistant TB.